Meningitis case
May 23, 2019

30 y/o male patient medically free before , referred to ER by dermatology as patient having back pain with vesicular rash associated with headache and fever

+ve O/E: he has T38 , conscious, oriented, no rash , and + jolt accentuation test

Admitted as case of meningitis


WHAT IMPORTANT SYMPTOMS IN THE HISTORY THAT SUGGEST MENINGITIS?

  • Headache (87%)
  • fever (77%)
  • AMS (89%)
  • Neck stiff ( 31%)
  • 2/4 present in 95% of meningitis cases

HOW SENSITIVE AND SPECIFIC ARE THE MENINGEAL SIGNS ?

Sign SN SP
Kernig sign 5 95
Brudzinski sign 5 95
jolt accentuation test 97 60

BACTERIAL VS VIRAL ?

Viral Bacterial
WBC 50-1000 1000-5000
WBCd Lymphocyte PMN
Protein <200 100-500
Glucose >45 <40
Gram stain -ve 60-90%
Cultures -ve 75-85%

INDICATION OF CT BEFORE LP ?

Made by Mohammed Zammo

FEW NOTES

  • VIRAL meninigtis –> within 48h can be PMN after can be Lymphocytic
  • IgG and IgM in meningitis >> not considered in meninigits workup ,
    importnatn in looking for immune status of the patient
  • 5-10 days for IgM to become +ve
  • 14-1 M for IgG to be +ve
  • Acyclovir only cover Herpes
  • most common virus is Enterovirus